The Public Health and Air Pollution in Asia (PAPA) project: Estimating the mortality effects of particulate matter in Bangkok, Thailand

BACKGROUND: Air pollution data in Bangkok, Thailand, indicate that levels of particulate matter with aerodynamic diameter <= 10 mu m (PM10) are significantly higher than in most cities in North America and Western Europe, where the health effects of PM10 are well documented. However, the pollution mix, seasonality, and demographics are different from those in developed Western countries. It is important, therefore, to determine whether the large metropolitan area of Bangkok is subject to similar effects of PM10. OBJECTIVES: This study was designed to investigate the mortality risk from air pollution in Bangkok, Thailand. METHODS: The study period extended from 1999 to 2003, for which the Ministry of Public Health provided the mortality data. Measures of air pollution were derived from air monitoring stations, and information on temperature and relative humidity was obtained from the weather station in central Bangkok. The statistical analysis followed the common protocol for the multicity PAPA (Public Health and Air Pollution Project in Asia) project in using a natural cubic spline model with smooths of time and weather. RESULTS: The excess risk for non-accidental mortality was 1.3% [95% confidence interval (CI), 0.8-1.7] per 10 mu g/m(3) of PM10, with higher excess risks for cardiovascular and above age 65 mortality of 1.9% (95% CI, 0.8-3.0) and 1.5% (95% CI, 0.9-2.1), respectively. In addition, the effects from PM10 appear to be consistent in multipollutant models. CONCLUSIONS: The results suggest strong associations between several different mortality outcomes and PM10. In many cases, the effect estimates were higher than those typically reported in Western industrialized nations.